Therapists’ understandings and experiences of working with clients with problems of addiction: A pilot study using Q methodology

Abstract

This pilot study aims to increase our understanding of therapists’ subjective attitudes, beliefs, and experiences of working with clients with problems of addiction. The study yielded useful clarifications, arising from the finding that opinions about the nature of addiction support different approaches to therapy. In addition, it seems that diverse or conflicting attitudes and beliefs are likely to impact on the ability of therapists to work together effectively. Another objective was to test the feasibility of using Q methodology in this study and more broadly in qualitative research in psychotherapy. Participants were 13 therapists from a variety of backgrounds and working in a range of agencies. Using Q methodology, four distinctive factors were identified, indicating divergent understandings of addiction. Each factor is shown to be a multifaceted construct which does not correspond to any single theory or therapeutic orientation. It is suggested that the results have significant implications for therapists’ training and supervision. In addition, this study demonstrates the capacity of Q methodology to identify commonalities and diversity in viewpoints which do not conform to a priori conceptualisations. As a pilot study, this paper invites further discussion and research.

Keywords:

• Addiction
• therapist understanding
• therapist beliefs
• therapist values
• Q methodology
• qualitative research methodology

Notes

¹Q methodology has been used in various fields, for example in studies of health and illness (e.g., Stainton Rogers, 1991; Stenner et al., 2000), in feminist studies (e.g., Kitzinger, 1987; Snelling, 1999), in research into self-harming behaviour (Rayner & Warner, 2003), and in exploration of emotions such as jealousy (Stenner & Stainton Rogers, 1998) and love (Watts & Stenner, 2005b). Yalom and his colleagues used Q methodology in their studies of the therapeutic factors in group therapy (a detailed account appears in Yalom & Leszcz, 2005). McLeod and Ryan (1993) used Yalom's set of statements in their study of therapeutic factors in an out-patient therapy group for older women.

²To enable participants to engage with subtle nuances of a topic, we retained some statements which seemed partially overlapping, for example statement 11 (‘Abstinence is crucial for recovery’) and statement 58 (‘I accept that a client may not wish to aim for abstinence’). Participants engaged with these statements in ways which indicate an appreciation of a difference: for example in factor A abstinence is not considered crucial for recovery and therefore it seems highly plausible that there will be a strong support for statement 58, while in factor C strong disagreement with statement 58 indicates an expectation that clients will aim for abstinence, although support for the view that abstinence is crucial for recovery is moderate. Perhaps expectation of abstinence is seen as a policy decision rather than an expression of a treatment philosophy.

³There is also a freeware package, PQMethod-2.11d (available from: http://www.rz.unibw muenchen.de/∼p41bsmk/qmethod),

⁴The fifth factor (factor E) was not considered sufficiently distinctive as the two participants who loaded on this factor also loaded significantly as other factors. The factors were rotated to obtain a pattern of loadings on each factor that was as diverse as possible. The varimax procedure was used in this study, as suggested by Watts and Stenner (2005a). For a factor to be interpretable, one requirement is an eigenvalue greater than 1.0 (an eigenvalue is the sum of squared loadings for a factor; it conceptually represents the amount of variance accounted for by a factor). A second requirement is that a factor must have at least two sorts that load significantly upon it alone. The Q-sorts of all participants who loaded significantly on a factor were merged to produce a single configuration which serves as a factor array, or factor exemplar, used as the basis for factor interpretation.

⁵For example, in a study by Hollander et al. (2006), over 43% of the counsellors identified themselves as recovering from drug or alcohol addiction. In two earlier studies the rate of counsellors in recovery was 57% (Hshieh & Srebalus, 1997) and 58% (Doyle, 1997).

⁶For example, Rogers and Dymond (1954) used the Q-sort technique (without using factor analysis) to measure mental health by comparing the Q-sorts of mental patients against a Q template of the ‘ideally healthy person’.